Healthcare Provider Details

I. General information

NPI: 1114221280
Provider Name (Legal Business Name): PROFESSIONAL SERVICES OF HOLY CROSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 FARRAGUT AVE
KENSINGTON MD
20895-2110
US

IV. Provider business mailing address

PO BOX 531863
ATLANTA GA
30353-1863
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-4242
  • Fax: 301-949-8041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE KEESE
Title or Position: VP & CFO
Credential:
Phone: 301-754-7201